Department of Dermatology, Brigham & Women's Hospital, Chestnut Hill, Massachusetts.
Dermatol Ther. 2018 Nov;31(6):e12701. doi: 10.1111/dth.12701. Epub 2018 Sep 24.
Atopic dermatitis is characterized by skin barrier abnormalities and immune dysregulation with increased T 2 signaling playing a central role. Investigations of allergic contact dermatitis suggest that certain allergens may also activate particular T cell signatures such as T 2-dominant responses to fragrance and rubber. We present a case series of patients with allergic contact dermatitis who were successfully treated with dupilumab, a biologic developed for atopic dermatitis that dampens T 2 signaling. In our cohort of three patients, two had extensive allergic contact dermatitis on their torso and extremities primarily due to textile and rubber allergens. The third was a hairdresser with severe hand dermatitis due to occupational allergens. Two of the three patients had no history of atopic dermatitis during childhood. Each patient experienced at least 90% improvement in body surface area involvement and continues to maintain their clinical response on dupilumab (range 6-13 months). Our hypothesis that dupilumab suppressed contact allergic reactions is supported by the identification of clinically relevant contact allergens on patch testing, acute onset and/or worsening of dermatitis in adulthood, and absence of childhood atopic dermatitis in two cases. Further, larger investigations to understand which factors affect responses of allergic contact dermatitis to dupilumab are warranted.
特应性皮炎的特征是皮肤屏障异常和免疫失调，2 型 T 细胞信号转导增加起着核心作用。对过敏性接触性皮炎的研究表明，某些过敏原也可能激活特定的 T 细胞特征，如对香料和橡胶的 2 型主导反应。我们报告了一系列成功接受度普利尤单抗治疗的过敏性接触性皮炎患者病例，度普利尤单抗是一种针对特应性皮炎开发的生物制剂，可抑制 2 型 T 细胞信号转导。在我们的三例患者队列中，有两例因接触纺织品和橡胶过敏原而出现广泛的过敏性接触性皮炎，主要分布于躯干和四肢；另一名理发师因职业接触过敏原而患有严重的手部皮炎。这三例患者中有两例在儿童时期没有特应性皮炎病史。每位患者的体表面积受累均至少改善了 90%，并继续保持度普利尤单抗的临床应答（6-13 个月不等）。我们的假设是，度普利尤单抗抑制了接触性过敏反应，这一假设得到了临床相关接触过敏原斑贴试验、成年后皮炎的急性发作和/或加重以及两例患者无儿童期特应性皮炎的证据支持。此外，需要进一步开展更大规模的研究，以了解哪些因素影响过敏性接触性皮炎对度普利尤单抗的反应。
